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Social Media and Anonymity

Articles discussing the ethics of social media use by physicians are quite popular. Asking whether or not it’s appropriate for doctors and patients to contact one another through Facebook, twitter, blogs, or other media seems to be the question of the hour. For physicians who choose to blog or tweet (instead of, or in addition to, Facebook) the question becomes whether it should be done anonymously.

I confess to not understanding what all the fuss is about. People who represent themselves as professionals ought to act professionally – both in person and online.

Facebook

Why is there any dilemma as to whether or not a doctor should accept a friend request on Facebook? People who don’t have a doctor/patient relationship with one another can friend one another with no ethical repercussions. If two people who are friends outside of the doctor/patient relationship want to socialize online too, then that shouldn’t be a problem. On the other hand, if it wouldn’t be appropriate to go out to dinner, a ballgame, or otherwise socialize, then FB friend requests should be declined with the same tact as in-office awkwardness that occasionally arises.

Anonymity

An even bigger topic is that of anonymity. I find it amusing to read the multitude of accusations that it is wrong for doctors to blog anonymously. It should be no surprise that I don’t think it’s wrong for people to blog without publishing their names (read here). The issue for doctors (in this patient’s insignificant opinion), is one of professionalism.

If the reason for remaining anonymous is to make it possible to say things that would be construed as unprofessional coming from a doctor, then it’s unprofessional to make those posts – even anonymously. Some medblogs are platforms for complaining about what a burden it is to deal with patients, and how horrible medical professionals have it. The problem with these blogs isn’t the anonymity, it’s the unprofessionalism that’s trumpeted publicly for all the world to see. If it’s not something that you’d sign your name to – big and bold as John Hancock - then it’s not up to professional standards becoming of a physician.

There are two medblogs I like that are done anonymously. Those doctors come across as professionals who care about their patients. If their names were to be exposed, they wouldn’t have to be ashamed of what they’ve written.

Unfortunately, those are in the minority. No matter how many times patients hear doctors say that they won’t judge people (their job is to help, not judge), it is obvious from many anonymous medblogs that doctors and nurses judge patients quite severely. What do doctors really think about patients? Read some anonymous medblogs. Whether or not that’s the majority opinion is hard to tell, but it is what doctors are shouting from the rooftops on the internet.

A blog is a public presentation. People form an impression of the medical profession based on the exposures they have, including what is presented on the web. If what patients learn about how doctors think and behave is based on the critical attitudes trumpeted from many anonymous medblogs, it’s no wonder that the younger segment of our society no longer respects doctors the way people did in the past.

When I’m writing a post, I don’t think, “This is anonymous, so I can say anything I wish and never be concerned about repercussions.” I think, “There’s no real anonymity on the internet. Someone who really wanted to know my identity could probably figure it out, so I should be careful what I say.” Would you be willing to own your posts? Sign your name to them? Or would you squirm uncomfortably and have to make excuses about their content? There is no problem with blogging anonymously – as long as the writing is done so that the author’s name could be attached.

Using social media anonymously is not a problem. Unprofessionalism is. People who represent themselves as professionals ought to act professionally – both in person and online, regardless of whether their name is published.

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11 thoughts on “Social Media and Anonymity”

Great comments about professionalism. It is a word that, sadly, is almost exclusively used in negative discussions about being professional. We need a new word for what physicians should be about to start all over and get a positive meaning.
Many anonymous medical bloggers are employed physicians or easily identified contracted physicians who feel muzzled by that relationship from accurately expressing opinions that may benefit patients or the profession. These folks blog anonymously to try to serve all. Other bloggers are covered by your comments about whining and maligning patients which, as you point out so nicely, may enable patients to get a broader perspective of physiciandom. Very important post. Thanks.

You make an excellent point about the fact that we should be able to sign our name to our posts. I debated for a long time whether or not to put my face on my blog. I chose to do it for my fellow bloggers, knowing that I was risking my identity if friends stumbled across my blog in the future. It’s a risk I’m willing to take though. I have, however, chosen to leave my name off my blog so a google search doesn’t reveal me right away. But I do sign it to posts on other’s blogs.

It is a tough spot sometimes because on the one hand, we need to be able to vent and sometimes that means stepping on toes. But on the other hand, we have to be careful about how much we share in the event that we are discovered by those we have chosen not to share our blog with.

I sure wouldn’t mind my old rheumatologist stumbling across my blog though! And if my friends eventually find me. Well, maybe they will recognize themselves in my words and feel convicted.

Great post! Food for thought indeed. BTW, I have the utmost respect for your decision to blog anonymously. -Kelli

Hi! I wondered if you would be willing to share the the anonymous blogs you visit? Maybe visiting there will change my opinion? Anonymous doctor posts often scare some patients to death (I remember a paramedic saying after one thread she was now terrified to take some patients into the ER). They tend to rant….not really reveal much.

I want to give Dr.Jonas a public kudos.

I will admit I struggle with anonymous posters, whether they be doctors or dogs! :). Under the guise of a type of invisible poster people tend to be edgier which may come across as honest…..but in a way it is dishonest when they do not share who they are. I understand it, but wish there was more honesty in medicine. Isn’t that what patients are screaming for?

Some view themselves as the Watergate Deepthroat….but overall…..I have not been enlightened much….yet….on second thought there is a lawyer over an Kevin’s who posts anonymously….he is blatantly honest, makes the docs uncomfortable… and creates some of the best counter debates I have seen (and I do not agree with him at times, but it is illuminating).

Alice, I considered naming names, but decided not to. First, one person can’t possibly read all the available blogs; there are sure to be good ones that I’m not following. Of the medblogs that I read the vast majority of the anonymous blogs would likely not write as they do if a real identity was attached. It’s entirely likely that there are anonymous blogs I don’t read that have perfectly acceptable content and are respectful toward patients. Funny you should mention anon ER blogs, since they are the worst offenders, imo.

Also, I started reviewing the list of blogs I read (146) and discovered a couple other blogs I like very much that I hadn’t realized are anon. Switch that “2” to “4”

Hmmm……I am genuinely sorry but this doesn’t make sense. You won’t give the URL to anonymous blogs? That’s not really helpful, now is it? Protecting the anonymous? Okay….I need some cyber counseling for cyber logic, because I am having a “Duh!” moment! :) Not unusual mind you!

I see it from the medical profession side as well as from the patient side. Take a couple of days and just go sit in the waiting room of a major hospital. We in the medical profession would love our jobs and our patients much more if: people would use ERs for true emergencies, and go to a walkin clinic for non-emergencies. In an ER, we are trying to give every patient the attention they NEED – which is not necessarily the attention they WANT.
Many MDs and RNs don’t realize how many things people don’t know and how many things they misunderstand. They become frustrated with people who don’t understand basic health information. In the ER situation – and even in the usual office setting – there is little to no time to explain basic health information.
I’m no longer in the workforce, but I still encounter total misunderstanding about medical information – even among my own family members! YIKES! I try to be patient, but it takes a LONG time to correct that misunderstanding and misinformation. Time is at a premium at most offices and in ALL ER’s.
So, at least some of the blogs are reflecting the frustration with patient’s lack of basic health information and their desire to teach the patients but having no time to do it.
Then there are the really unprofessional comments. I won’t even talk about those.
Cheerio!
Elizabeth

Elizabeth are you British? I ask because I lived in the UK, and brought home a Scottish husband (he was my aunt’s neighbor).

I have RA and spinal stenosis too, so I appreciate the posts. And any help you can share.

Although, it seems we relate to situations as we experience them. Doctors post anonymously not to help patients, but it seems as a way of venting…….I believe it’s their therapy…just as it with patients. I like to read both sides….not that it’s always enjoyable…it is educational.

I believe two of the most helpful doctors are the two from Boston (something in the water there….must be truth serum). Dr. Jerome Groopman and Dr. Atul Gawande have wrote two of the most revealing, helpful books for patients, and they did so without going undercover. It lends an authenticity to their words. I believe anonymous posts are limited because they tend to help the poster more than anyone else. Yet, these books, particularly, the one from Dr. Groopman about how doctors think, is illuminating. I read Dr. Gawande’s book right before my daughter’s neck dissection a few months ago. My fingers were typing e-mails faster than they could be read…I was completely panic stricken at what he shared that goes wrong in the OR (and developed a check list), and the privileges doctor’s take, and patient’s being practiced on by residents. I kept a 24 hour vigil at my daughter’s bedside out of terror….maybe that’s a good thing? I believe his writings will save lives. Both of these doctors seem to have a strong desire to serve patients. They took a risk which could have been costly to them at a personal level, but because they stood by their words with their own reputation they have gained immeasurably (as we have). Maybe that’s what I see missing from anonymous doctor’s posts?